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Outbreaks of E. coli O104:H4 infection

Countries in the WHO European Region have reported significant numbers of infections from verocytotoxin-producing Escherichia coli O104:H4, resulting in a large number of cases of bloody diarrhoea and haemolytic uraemic syndrome (HUS) in Germany, and in 15 other countries in Europe and North America. More recently, another cluster of cases in the Bordeaux region of France, and a single case in Sweden, have been reported.

WHO supports coordination of information sharing through the International Health Regulations, the International Food Safety Authority Network (INFOSAN) and other reporting mechanisms; it is monitoring the outbreaks, and providing the latest information. WHO is working closely with national health authorities and international partners to detect the unusual bacterial strain and track down its source.

The number of new cases of Escherichia coli O104:H4 infection in Germany and France is much diminished. The figures reflect some delayed reporting, and the evidence indicates that the outbreak, which took 50 lives in Germany alone, is nearly over.

On 5 July, the European Food Safety Authority (EFSA) issued the report from the Task Force established to coordinate investigations to track down the possible source of the French and German outbreaks of E. coli O104:H4. Details of the task force report and its conclusions can be found on the EFSA website.

On 28 June 2011, the Institut de veille sanitaire, France, published new figures for the verocytotoxin-producing Escherichia coli (VTEC)/haemolytic uraemic syndrome (HUS) outbreak in the Bordeaux region in France, where in total 8 cases of bloody diarrhoea and 8 HUS cases have been reported since 22 June. E. coli O104:H4 infection has been confirmed in 4 of these cases. Also on 28 June, Sweden reported a confirmed case of E. coli O104:H4 infection in southern Sweden in an adult male. None of these patients in France or Sweden had travelled in Germany since 1 May 2011.

Until the investigations into the outbreaks of E.coli O104:H4 infection have been completed, WHO advises consumers in the WHO European Region that bean sprouts or sprouted seeds – whether commercially or home grown – should only be eaten when they have been thoroughly cooked. E. coli bacteria are killed at a cooking temperature of 70 °C.

On 28 June 2011, the Institut de veille sanitaire published new figures for the verocytotoxin-producing Escherichia coli (VTEC)/haemolytic uraemic syndrome (HUS) outbreak in Bordeaux, France. On 28 June, Sweden reported a confirmed case of E. coli O104:H4 in southern Sweden in an adult male.

Over the last week, the number of reported HUS/EHEC cases has declined to a significantly lower level than previously. Investigations by the German authorities indicate that the vehicle of the bacterium responsible for the outbreak, enteroaggregative verocytotoxin-producing Escherichia coli (EAggEC VTEC) O104:H4, is bean and seed sprouts, and the Robert Koch Institute has warned people in Germany not to eat raw bean and seed sprouts of any origin.

On 10 June, German authorities stated that mounting epidemiological and food-chain evidence indicated that bean and seed sprouts (including fenugreek, mung beans, lentils, adzuki beans and alfalfa) are the vehicle of the outbreak in Germany.

On 10 June, German authorities stated that mounting epidemiological and food-chain evidence indicated that bean and seed sprouts (including fenugreek, mung beans, lentils, adzuki beans and alfalfa) are the vehicle of the outbreak in Germany.

The enterohaemorrhagic Escherichia coli (EHEC) outbreak in Germany has reinforced the importance of speed, coordination, information-sharing and preparedness, said WHO Regional Director for Europe, Ms Zsuzsanna Jakab.

The outbreak remains primarily centred in Germany. The authorities now recommend that people in Germany should not eat raw bean and seed sprouts of any origin. Households, caterers and restaurants should dispose of any bean and seed sprouts they have, and any food items that might have been in contact with them, until further notice.

On 10 June, German authorities stated that mounting epidemiological and food-chain evidence indicated that bean and seed sprouts (including fenugreek, mung beans, lentils, adzuki beans and alfalfa) are the vehicle of the outbreak in Germany.

The outbreak remains primarily centred in Germany, and investigations continue into both the nature of the unusual enteroaggregative verocytotoxin-producing Escherichia coli (EAggEC VTEC) O104:H4 bacterium, which is causing the outbreak, and its source.